Although pain is a universal, complex biological and emotional experience it is very difficult to define clearly. The International Association for the Study of Pain (IASP) defines pain as "the unpleasant aesthetic and emotional experience associated with established or potential tissue damage or described in these terms" (IASP, 1986: S217).
Pain classification
The two main types of pain are fast and slow pain. Rapid pain is a feature of acute pain, it is the most rapidly perceived pain.
It is found mainly in superficial injuries and is not perceived by the majority of the deep tissues of the body. Night pain is a feature of chronic pain. It is described as deep pain or burning pain and is transmitted with a delay of one second, while then its intensity increases. It is associated with tissue damage, lasts a long time and is transmitted by any superficial and deep tissue of the body (Guyton & Hall, 1998: 715-716)
Mostly depending on its duration, the pain is divided into: 1) transient pain, 2) acute pain and 3) chronic pain.
Transient pain is characterized by its short duration and is usually due to common minor traumatic situations. Its characteristic is that its first rapid, quite strong, acute appearance is accompanied by a consequent secondary feeling of slow perception of deep pain where it ends in the remission of the pain.
Acute pain is characterized by a specific time of onset and limited duration. It usually has a specific and identifiable causal relationship with the injury and the duration of its onset.
Acute pain is accompanied by great intensity and accompanies more serious traumatic or pathological conditions.
Chronic pain is characterized by its long duration. It can be reported even if the injury or pathology of the area has occurred or even if there is no identifiable pathological cause (Johnson, 2005: 45-47), (Dawn & co, 2009: 3). Chronic pain is defined as pain that persists beyond the normal phase of an acute illness or beyond a reasonable amount of time where healing should occur. Chronic pain can be caused by chronic pathological and long-term dysfunction of certain parts of the peripheral or central nervous system or both.
Pain is a symptom that protects the body by pushing the person to find the cause that causes it and to deal with it. Chronic pain, however, is a chronic harmful disease that in turn causes other diseases, negatively affecting the brain and psyche of the person experiencing it, the quality of life and perhaps the expectation of survival, depending on the cause that causes.
A pain to be defined as chronic should be more than 3 months and is usually due to either a chronic disease, or an initial stimulus that either continues but at a mild intensity, or the person experiencing it is overly sensitive to pain, even in the mild.
How does chronic pain affect the quality of life?
Quality of life is defined as: the perception of the individual about his attitude to life in relation to the values and ideals of the environment in which he lives and in relation to his personal goals, ambitions, and perceptions.
Health-related quality of life includes many dimensions, the most common of which are: a) physical health b) psychological well-being, c) social well-being, d) functional ability, e) mental well-being and f ) life satisfaction. The focus is on how dimensions are affected by disease or treatment.
Also the relationship between quality of life and health, is a complex conceptual whole that includes at least three dimensions, the physical, the psychological and the social. Physical function is often defined as the performance, or ability to perform activities of daily living, when physical symptoms are manifested, either by illness or by treatment. The four most commonly considered categories are: self-care activities (feeding, washing, dressing, using the toilet), mobility (ability to move around indoors and outdoors), physical activity (walking, climbing stairs), and performance. roles (activities related to school, work).
Psychological functionality varies, from severe depression to a positive sense of well-being and can also contain cognitive function. Social functionality refers to quantitative and qualitative expressions of social relationships and interactions and to social integration. The spiritual needs, mental anguish and spiritual well-being of patients with serious illness can affect their quality of life.
Physiotherapy in chronic pain
Physiotherapists have the knowledge and skills needed to help as health professionals improve the quality of life of people, to promote, prevent, treat, intervene and restore movement and function that are threatened by age, injuries, diseases, disorders or other factors and conditions.
How can physical therapy help?
Physiotherapy is inextricably linked to the quality of life of the individual. Physiotherapy promotes, supports and restores not only the physical, but also the psychological and social health, as it aims at the complete reintegration of the individual in his work and social environment.
The physiotherapist helps patients with chronic pain develop the ability to take matters into their own hands, increase their activity and quality of life. Through exercise they will increase their flexibility, their strength, will improve their cardiovascular system and mood.
One of the most important goals in the treatment of chronic diseases is to maintain the best possible quality of life and independence of patients. The role of physiotherapy in achieving this goal is crucial as through the application of various techniques and means, it allows people with chronic diseases to maintain and improve their functionality and therefore be more productive and independent in their daily skills.
Physiotherapy will reduce the fear associated with pain, and explore long-term strategies that will increase confidence in movement and activities so that the patient can overcome the problem and return to a normal lifestyle.
The cooperation of the physiotherapist with the patient is very important in order for the patient to comply with the treatment program but also to understand the reasons why he should practice.
In chronic conditions which include painful flares and inflammatory reactions, physiotherapy can intervene with the application of natural means (electrotherapy, ultrasound, laser) and cryotherapy in order for the patient to be relieved of the symptoms and to be able to actively follow the program for of its functionality.
The main goal of physiotherapy intervention in order for the patient to remain functional, is to maintain the range of motion of the joints. This is achieved by applying special mobilization techniques, exercises that promote mobility as well as by applying stretches to increase the elasticity of the muscle groups that surround the affected joints.
Muscle strengthening exercises are also very important for the patient's mobility and improving his physical condition. Strengthening the muscular system reduces the strain on the joints and increases the patient's motor performance, which promotes his independence, self-confidence and functionality.
The purpose of physiotherapy is:
• The patient's mobility (ie getting out of bed, sitting in a chair, going to the bathroom)
• The balance of movements (ie the good sense of space, time and movement)
• Muscle elasticity (especially after years in bed)
• The strengthening of the muscles without excessive fatigue
• The reduction of the symptoms from the musculoskeletal system and the treatment and improvement of the physical condition, which has been aggravated due to the disease
The most common symptoms that a physiotherapist has to deal with are:
• Musculoskeletal pain (back pain, neuralgia, muscle contractions and arthritic pain)
• Musculoskeletal weakness (gait, balance, clothing)
• Fear of movement
• Fatigue (due to poor physical or mental condition, due to medication, due to stress and due to movement)
• Respiratory difficulty (cough, "shallow" breathing or exhalation)
Other difficulties that occur due to the above are:
• The execution of daily activities, personal hygiene and cleanliness
• Bathing, shaving, hairstyle
• Clothing, change of clothes, shoes
• Moving, raising and lowering the ladder
References
· Hajihasani A, Rouhani M, Salavati M, Hedayati R, Kahlaee AH. The Influence of Cognitive Behavioral Therapy on Pain, Quality of Life, and Depression in Patients Receiving Physical Therapy for Chronic Low Back Pain: A Systematic Review. PM R. 2019 Feb;11(2):167-176.
· Tsuji T, Matsudaira K, Sato H, Vietri J, Jaffe DH. Association between presenteeism and health-related quality of life among Japanese adults with chronic lower back pain: a retrospective observational study. BMJ Open. 2018 Jun 27;8(6):e021160.
· Jung SH, Kwon OY, Yi CH, Cho SH, Jeon HS, Weon JH, Hwang UJ. Predictors of dysfunction and health-related quality of life in the flexion pattern subgroup of patients with chronic lower back pain: The STROBE study. Medicine (Baltimore). 2018 Jul;97(29):e11363.
· Waterschoot FPC, Dijkstra PU, Hollak N, de Vries HJ, Geertzen JHB, Reneman MF. Dose or content? Effectiveness of pain rehabilitation programs for patients with chronic low back pain: a systematic review. Pain. 2014 Jan;155(1):179-189.
· Nolet PS, Kristman VL, Côté P, Carroll LJ, Cassidy JD. Is low back pain associated with worse health-related quality of life 6 months later? Eur Spine J. 2015 Mar;24(3):458-66.
Elpis Nicolaou, Bsc
Licenced Physiotherapist & Clinical Pilates Instructor [A.M 1119]